COVID-19: Health authorities say plasma treatment still 'experimental therapy'

As the demand for convalescent plasma surged across the country with doctors urging patients who recovered from COVID-19 to donate their plasma, health authorities urged people not to pay donors as the treatment was still "an experimental therapy". 

Health authorities said that no remuneration for the donor from a healthcare setting or from patients has been allowed or is permissible under the WHO guidelines. 

“There are reports that doctors are prescribing convalescent plasma for the treatment of COVID-19 patients and asking the attendants to arrange the CP on their own. This is not permissible as its use is still an experimental therapy in Pakistan like elsewhere in the world,” an official of the National Health Services, Regulations and Coordination (NHSR&C) told The News on Monday.

The NHSR&C also issued general guidelines titled “Use of Convalescent Plasma in COVID-19 Patients” for the public health facilities, healthcare settings and professionals and the general public, clearly mentioning that convalescent plasma should only be considered as “experimental therapy for COVID-19 patients in Pakistan”.

The official further warned that people should refrain from paying money to donors for convalescent plasma as this had not been deemed permissible by health authorities and as per the WHO's guidelines, adding that there was no evidence whether this therapy works or not in the treatment of COVID-19 patients anywhere in the world at the moment.

But the demand for convalescent plasma has surged to an extent that the National Institute of Blood Diseases (NIBD), which has been allowed by the Pakistan government to collect plasma from recovered patients of the COVID-19 and use it as treatment therapy on an experimental basis, received 800 calls for the supply of convalescent plasma in a single day on Sunday as people from entire Pakistan, especially Punjab and Khyber Pakhtunkhwa, are desperately looking for the plasma of recovered patients to save the lives of their loved ones.

The federal health ministry official said there were reports of people asking money for the provision of convalescent plasma, but he warned that strict action would be initiated against such people. He added that healthcare commissions of all the provinces had been directed to take action against labs that were illegally collecting convalescent plasma in some areas of Lahore and Karachi.

“Any COVID19 patient enrolled in a permitted clinical trial can only be eligible for receiving the investigational therapy i.e. CP under the supervision of a qualified physician in an approved health facility. There could be various eligibility and ineligibility criteria based on the trial protocol,” the national health services official said and made it clear that so far the use of convalescent plasma “has not been declared as a treatment for COVID-19” anywhere in the world.

What do physicians say?

Dr Tahir Shamsi, a renowned hematologist and lead investigator of clinical trials on the use of convalescent plasma for the treatment of COVID-19 patients, said he never claimed the therapy to be a definite treatment. He said it was experimentally being used under international guidance for the treatment of COVID-19 patients at selected healthcare settings all over the country, and they were having mixed results as trials were still ongoing.

“But many physicians, especially those in Punjab and KP, have started prescribing convalescent plasma for the treatment of COVID-19, forcing people to use all means to get the bag of plasma to save the lives of their loved ones, who are infected with the coronavirus. Only on Sunday, we received over 800 calls from across Pakistan and people asked for the supply of convalescent plasma after doctors asked them to arrange it for their under-treatment patients,” Dr Tahir Shamsi said.

To a query, he said the clinical trial on the use of CP was underway, and health officials were receiving some very good results from some of the health facilities where most of the patients who received the plasma recovered and discharged from the hospitals. But he also conceded that there were some “disappointments” where proper care was not provided to patients, especially at some public health facilities in the country.

“The goal of our clinical trial is to prevent COVID-19 patients from [being put on] the ventilators. The antibodies in the convalescent plasma of a recovered patient neutralise the virus in the body of an affected patient and help him recover rapidly without allowing the virus to damage the vital organs of the patient, especially the lungs,” he said.

Lauding the NHSR&C for issuing guidelines on the use of convalescent plasma, he said these should have been issued at least three or four weeks earlier, as, in their absence, a lot of physicians started prescribing CP as “a definite treatment of COVID-19”, while people started using all means at their disposal to acquire the serum for the treatment of patients.

“More than 100 hospitals in India are conducting clinical trials on the convalescent plasma in COVID-19 patients. And here in our country, some hematologists are issuing policy statements against plasma use without knowing anything about the subject,” he added.

Harmful for the recipient?

On the other hand, the Pakistan Society of Hematology (PSH) claimed that the use of convalescent plasma could also be harmful to the recipient as there was no scientific proof of its benefit in the treatment of COVID-19 patients.

It added that massive advertisement and unnecessary hype had made people and some healthcare professionals believe that it was the standard treatment for the COVID-19, which had resulted in its misuse and illegal trade in the market. 

“We, the PSH, demand the health department and the regulatory bodies to immediately stop this illegal and potentially harmful plasma trade and regulate its judicial use,” PSH President Gen (retd) Dr Parvez Ahmed said in a policy statement.